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Children's Medical Services - Special services for children with special needs
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Module One: Lesson One

Early Steps: An Umbrella Program

little girl with umbrellaYou may not be aware that Early Steps is comprised of several programs that assist families with high risk or developmentally delayed infants and toddlers gain the services and skills they need to support their infants. Early Steps, within Children's Medical Services in the Florida Department of Health, is an umbrella program for infants and toddlers, birth to age three, and their families. The purpose of this umbrella program is to identify eligible infants early, to develop an Individualized Family Support Plan (IFSP) based on the family's concerns and priorities, and to coordinate the provision of early intervention services and related supports. These programs consolidate to provide a comprehensive, coordinated program of family-responsive services for infants and toddlers. The state-funded Developmental Evaluation and Intervention (DEI) Program, part of Chapter 393, Florida Statutes, and the federal Individuals with Disabilities Education Act (IDEA) Program for Infants and Toddlers with Disabilities (Part C) are all under the umbrella of the CMS Early Steps system. Let us take a closer look at each of these three programs beginning with the Developmental Evaluation and Intervention (DEI) Program.

Developmental Evaluation and Intervention (DEI) Program
The Florida Legislature provided for the establishment of Developmental Evaluation and Intervention (DEI) Programs, including infant hearing impairment services, at designated hospitals, which provide level II, or III neonatal intensive care services through Chapter 391, Part III, Florida Statutes. The DEI Program has been providing services since the late 1970s.

The Developmental Evaluation and Intervention (DEI) program component is a coordination of services program intended to enhance the family's ability to maximize their child's potential. It is intended to provide comprehensive assessments of the needs of infants and toddlers who have received services in the Neonatal Intensive Care Unit (NICU) of designated hospitals, infants identified as hearing impaired or at high risk of hearing impairment, and infants who have been referred by the CMS Genetics/Infant Screening Program. Infants identified in a NICU must meet medical as well as family income eligibility to receive services under this program component. There is no financial eligibility criteria for infants identified with hearing impairments.

The focus is on early identification and the provision of service coordination. Service coordination assures that the infant and family receive specific services to address the concerns, priorities, and outcomes identified in the Individualized Family Support Plan (IFSP) and coordinates the provision of intervention and assistance, as needed, to infants and their families.

The DEI program component can also include audiological monitoring for infants found to be at high risk for late onset hearing loss (after the first month of life). All children born in Florida receive newborn hearing screening, typically before discharge from the hospital. Children with confirmed hearing loss in one or both ears are eligible for Part C services under Established Conditions and can receive services through a subcomponent of Early Steps called SHINE (Serving Hearing Impaired Newborns Effectively). SHINE services include those by the SHINE provider and ongoing services from hearing specialists in the community and/or local school districts that may provide early intervention services for children with hearing impairments.

The DEI state-funded program serves infants and toddlers who meet the following criteria:

  • Families must meet income criteria that is equal to or less than the Medicaid income eligibility limit for family size.
  • Infants who have been served in the neonatal intensive care unit of designated hospitals and who meet certain medical criteria for being at high risk for developmental delay, such as extreme low birth weight, or low Apgar score cards. Complex family psychosocial conditions, which in combination with one or more of the above medical/health concerns for the infant, would place the child at significant developmental risk.
  • Infants identified as having a diagnosed hearing impairment. There is no financial eligibility criteria for infants identified with hearing impairments.

For more information on the DEI program specific to your area, contact your local Early Steps.

Chapter 393, Florida Statutes
Chapter 393, Florida Statutes, provides for the provision of services for individuals with developmental disabilities. Children from birth to 36 months of age who are eligible under this chapter represent a similar population to those infants and toddlers eligible under the federal IDEA Part C program. For that reason responsibility for serving these children was transferred to Children's Medical Services (CMS) in January, 1994. Early Steps provides services under this chapter only for infants and toddlers who meet eligibility under the IDEA, Part C program. For more information on the Agency for Persons with Disabilities (formerly Florida's Developmental Disabilities Program), visit Agency for Persons with Disabilities.

The Individuals with Disabilities Education Act (IDEA)
The Individuals with Disabilities Education Act (IDEA), formerly the Education for the Handicapped Act (EHA), is the federal law that supports early intervention, special education and related service programming for children and youth with disabilities. The IDEA has its roots in Public Law 94-142 (the Education of All Handicapped Children Act), which was originally enacted in 1975 to establish grants to states for the education of children with disabilities. This law has been amended several times. In 1986, the EHA was amended by P.L. 99-457 to provide special funding incentives for states that would make a free and appropriate public education available for all eligible preschool-aged children with disabilities ages three through five. Provisions were also included to help states develop early intervention programs for infants and toddlers with disabilities; this part of the legislation became known as the Part H Program (now the Part C Program).

The EHA was amended again in 1990 by P.L. 101-476, which among other things, changed the name of the legislation to the Individuals with Disabilities Education Act, or IDEA. The IDEA was first amended in 1992 by P.L. 102-119. The newest amendments to this law are the Individuals with Disabilities Education Act Amendments of 1997 (P.L. 105-17).

On June 4, 1997, President William J. Clinton signed the bill reauthorizing and amending the Individuals with Disabilities Education Act (IDEA). The bill became Public Law 105-17, the Individuals with Disabilities Education Act Amendments of 1997. The law is commonly called "IDEA '97." IDEA is organized in four parts: Part A, General Provisions; Part B, Assistance for the Education of All Children with Disabilities (school age/preschool programs); Part C, Infants and Toddlers with Disabilities; and Part D, National Activities to Improve the Education of Children with Disabilities (support programs). P.L. 105-17 retains the major provisions of earlier federal laws in this area, including the assurance of having a free appropriate public education (FAPE) available to all children with disabilities, in the least restrictive environment (LRE), and the guarantee of due-process procedures and procedural safeguards. It also includes modifications to the law. In the area of early intervention services, which are now Part C, IDEA '97, those modifications are:

  • Requires that local school districts participate in a transition planning conference for parents of toddlers with disabilities who are about to enter preschool.
  • Explicitly calls for delivery of early intervention services in natural environments.
  • Clarifies that Part C funds for early intervention services are the payor of last resort.

Other Relevant Federal Legislation
In addition to IDEA, Part C, two other pieces of federal legislation are relevant to infants and toddlers with disabilities and their families: the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act. The spirit of ADA mandates the inclusion of persons with disabilities in all aspects of life. This inclusion begins at birth. Section 504 of the Rehabilitation Act is the basic civil rights provision for persons with disabilities.


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